Sumatriptan - Notes PDF

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SUMAtriptan succinate sue-mah-TRIP-tan Imitrex, Imitrex STATdose, Onzetra Xsail, Zembrace SymTouch Antimigraine drugs Serotonin 5-HT1 receptor agonists

Available Forms 4 mg/0.5 mL; 6 mg/0.5 mL prefilled syringes; 6 mg/0.5 mL vials; 3 mg/0.5 mL; 6 mg/0.5 mL single-dose autoinjector; prefilled-syringe 4 mg/0.5 mL; 6 mg/0.5 mL jet-injector 11 mg (base)/disposable nosepiece 5 mg/0.1 mL; 20 mg/0.1 mL 25 mg; 50 mg; 100 mg (base)

Indications & Dosages Acute migraine attacks (with or without aura) 1 to 6 mg subcut depending on product; maximum dose is 12 mg in 24 hours, separated by at least 1 hour. Or 25 to 100 mg PO, initially. If desired response isn’t achieved in 2 hours, may give second dose of 25 to 100 mg. Additional doses may be used in at least 2-hour intervals. Maximum daily oral dose, 200 mg. For nasal spray, give 5 mg, 10 mg, or 20 mg once in one nostril; may repeat once after 2 hours, for maximum daily dose of 40 mg. For nasal powder, one 11 mg nosepiece in each nostril (22 mg total), using the Xsail breath-powered delivery device. If desired response isn’t achieved in 2 hours, or migraine returns after a transient improvement, may give second dose of 22 mg. Maximum recommended dose within 24 hours is two doses (44 mg/4 nosepieces) or one dose of 22 mg and one dose of another sumatriptan product, separated by at least 2 hours. Adjust-a-dose: In patients with mild to moderate hepatic impairment, the maximum single oral dose shouldn’t exceed 50 mg. Cluster headache (except Zembrace) 6 mg subcut Maximum recommended dose is two 6-mg injections in 24 hours, separated by at least 1 hour.

Administration Give drug without regard for food. Give drug whole; don’t crush or break tablet. Redness or pain at injection site should subside within 1 hour after injection. Use injection site with adequate skin and subcutaneous tissue thickness to accommodate length of needle. Use only the abdomen or thigh for needle-free injection system. Have patient blow nose before use. Give medication on inhalation in one nostril, while blocking the other nostril. Use with the Xsail device only; insert disposable nosepiece into the device body. Pierce capsule inside nosepiece by pressing and releasing the white piercing button one time on the device body.

Insert nosepiece into one nostril, ensuring a tight seal; rotate device, place mouthpiece into mouth, and blow forcefully through mouthpiece for 2 to 3 seconds to deliver powder into the nasal cavity. Remove and discard nosepiece; repeat in other nostril, using a second nosepiece.

Action May act as an agonist at serotonin receptors on extracerebral intracranial blood vessels, which constricts the affected vessels, inhibits neuropeptide release, and reduces pain transmission in the trigeminal pathways. Route

Onset

Peak

PO

30 min

2–21/2

Subcut.

10 min

12 min

Unknown

Intranasal spray

15–30 min

1–2 hr

Unknown

45 min

Unknown

Intranasal powder Unknown Half-life: About 2 hours; intranasal, about 3 hours.

Duration hr

Unknown

Adverse Reactions CNS: dizziness, vertigo, drowsiness, headache, anxiety, malaise, fatigue. CV: pressure or tightness in chest. EENT: discomfort of throat, nasal cavity or sinus, mouth, jaw, or tongue; altered vision. GI: abdominal discomfort, dysphagia, diarrhea, nausea, vomiting, unusual or bad taste (nasal spray). Musculoskeletal: myalgia, muscle cramps, neck pain. Respiratory: upper respiratory tract inflammation and dyspnea (PO). Skin: injection-site or application-site reaction, tingling, diaphoresis, flushing. Other: warm or hot sensation, burning sensation, heaviness, pressure or tightness, tight feeling in head, cold sensation, numbness.

Interactions Drug-drug May enhance adverse or toxic effect of other serotonin modulators, increasing risk of serotonin syndrome. Monitor therapy. May prolong vasospastic effects. Don’t use within 24 hours of sumatriptan therapy. May reduce sumatriptan clearance. Use with or within 2 weeks of MAO inhibitor is contraindicated. May cause serotonin syndrome. Monitor patient closely for weakness, hyperreflexia, and incoordination if use together can’t be avoided. Drug-herb May increase serotonin levels. Use together cautiously.

Effects on Lab Test Results May increase liver enzyme levels.

Contraindications & Cautions Contraindicated in patients with hypersensitivity to drug or its components and in those with history, symptoms, or signs of ischemic cardiac, cerebrovascular (such as stroke or TIA), or peripheral vascular syndromes (such as ischemic bowel disease); hemiplegic or basilar migraine; significant underlying CV diseases, including angina pectoris, MI, and silent myocardial ischemia; Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders; uncontrolled HTN; or severe hepatic impairment. Contraindicated within 24 hours of another 5-HT agonist or drug containing ergotamine and within 2 weeks of MAO inhibitor.

Use cautiously in patient with risk factors for CAD, such as postmenopausal women, men older than age 40, or patients with HTN, hypercholesterolemia, obesity, diabetes, smoking, or family history of CAD. Dialyzable drug: Unknown.

Pregnancy-Lactation-Reproduction There are no adequate studies in pregnant women. Use only if potential benefit justifies potential risk to the fetus. Drug appears in human milk after subcut administration. Refer to individual manufacturer’s instructions regarding breastfeeding. Some manufacturers don’t recommend breastfeeding and other sources note that patient doesn’t have to discontinue breastfeeding.

Nursing Considerations Alert: When giving drug to patient at risk for CAD, give first dose in presence of other medical personnel. Rarely, serious adverse cardiac effects can follow administration. Alert: Combining drug with an SSRI or an SSNRI may cause serotonin syndrome. Symptoms include restlessness, hallucinations, loss of coordination, fast heartbeat, rapid changes in BP, increased body temperature, hyperreflexia, nausea, vomiting, and diarrhea. Serotonin syndrome may occur when starting or increasing the dose of drug, SSRI, or SSNRI. Monitor patient for seizures. Seizures have been reported in patients with and without a history of seizures. After subcut injection, most patients experience relief in 1 to 2 hours. Look alike-sound alike: Don’t confuse sumatriptan with somatropin.

Patient Teaching Inform patient that drug is intended only to treat migraine attacks, not to prevent them or reduce their occurrence. If patient is pregnant or may become pregnant, tell her not to use drug but to discuss with prescriber the risks and benefits of using drug during pregnancy. Tell patient that drug may be taken at any time during a migraine attack, as soon as signs or symptoms appear. Review information about drug’s injectable form, which is available in a spring-loaded injector system for easier patient use. Make sure patient understands how to load the injector, give the injection, and dispose of used syringes. Teach patient to select subcut administration sites with adequate subcutaneous tissue thickness. Teach patient using intranasal powder how to use Xsail device correctly. Teach patient to blow nose before using nasal spray. Patient should block other nostril while inhaling gently during administration and should keep head upright and breathe gently for 10 to 20 seconds after dose is given. Alert: Tell patient to report all adverse reactions and to immediately report persistent or severe chest pain. Warn patient to stop using drug and to call prescriber if pain or tightness in the throat, wheezing, heart throbbing, rash, lumps, hives, or swollen eyelids, face, or lips develop.

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